Abstract
Advanced minimally invasive techniques, such as robotic surgeries, are applied increasingly frequently around the world and are primarily used to improve the surgical outcomes of laparoscopic gastrectomy (LG). Against that background, we conducted a meta-analysis to evaluate the feasibility, safety, and effectiveness of robotic gastrectomy (RG). Studies comparing surgical outcomes between LG and RG patients were retrieved from medical databases, including RCTs and non-RCTs. The primary outcome of this study was overall survival, which was obtained by evaluating the 3-year survival rate and the 5-year survival rate. In addition, postoperative complications, mortality, length of hospital stay, and harvested lymph nodes were also assessed. We also conducted subgroup analyses stratified by resection type, body mass index, age, depth of invasion and tumour size. Ultimately, 31 articles met the criterion for our study through an attentive check of each text, including 1 RCT and 30 non-RCTs. A total of 12,401 patients were included in the analysis, with 8127 (65.5%) undergoing LG and 4274 (34.5%) undergoing RG. Compared with LG, RG was associated with fewer postoperative complications (OR 0.81; 95% CI 0.71–0.93; P = 0.002), especially pancreas-related complications (OR 0.376; 95% CI 0.156–0.911; P = 0.030), increased harvested lymph nodes (WMD 2.03; 95% CI 0.95–3.10; P < 0.001), earlier time to first flatus (WMD − 0.105 days; 95% CI − 0.207 to − 0.003; P = 0.044), longer operation time (WMD 40.192 min, 95% CI 32.07–48.31; P < 0.001), less intraoperative blood loss (WMD − 20.09 ml; 95% CI − 26.86 to − 13.32; P < 0.001), and higher expense (WMD 19,141.68 RMB; 95% CI 11,856.07–26,427.29; P < 0.001). There was no significant difference between RG and LG regarding 3-year overall survival (OR 1.030; 95% CI 0.784–1.353; P = 0.832), 5-year overall survival (OR 0.862; 95% CI 0.721–1.031; P = 0.105), conversion rate (OR 0.857; 95% CI 0.443–1.661; P = 0.648), postoperative hospital stay (WMD − 0.368 days; 95% CI − 0.75–0.013; P = 0.059), mortality (OR 1.248; 95% CI 0.514–3.209; P = 0.592), and reoperation (OR 0.855; 95% CI 0.479–1.525; P = 0.595). Our study revealed that postoperative complications, especially pancreas-related complications, occurred less often with RG than with LG. However, long-term outcomes between the two surgical techniques need to be further examined, particularly regarding the oncological adequacy of robotic gastric cancer resections.
Similar content being viewed by others
Data availability
All data generated or analysed during this study are included in this published article.
References
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784
Zhang C-D, Yamashita H, Zhang S, Seto Y (2018) Reevaluation of laparoscopic versus open distal gastrectomy for early gastric cancer in Asia: a meta-analysis of randomized controlled trials. Int J Surg 56:31–43
Marano A, Choi YY, Hyung WJ, Kim YM, Kim J, Noh SH (2013) Robotic versus laparoscopic versus open gastrectomy: a meta-analysis. J Gastric Cancer 13:136–148
Son T, Hyung WJ (2015) Robotic gastrectomy for gastric cancer. J Surg Oncol 112:271–278
Hashizume M, Sugimachi K (2003) Robot-assisted gastric surgery. Surg Clin North Am 83:1429–1444
Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Büchler MW (2004) Robot-assisted abdominal surgery. Br J Surg 91:1390–1397
Obama K, Sakai Y (2016) Current status of robotic gastrectomy for gastric cancer. Surg Today 46:528–534
Bobo Z, Xin W, Jiang L, Quan W, Liang B, Xiangbing D, Ziqiang W (2019) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: meta-analysis and trial sequential analysis of prospective observational studies. Surg Endosc 33:1033–1048
Chen K, Pan Y, Zhang B, Maher H, Wang X-F, Cai X-J (2017) Robotic versus laparoscopic Gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surg 17:93
van Boxel GI, Ruurda JP, van Hillegersberg R (2019) Robotic-assisted gastrectomy for gastric cancer: a European perspective. Gastric Cancer 22:909–919
Qiu H, Ai J-H, Shi J, Shan R-F, Yu D-J (2019) Effectiveness and safety of robotic versus traditional laparoscopic gastrectomy for gastric cancer: an updated systematic review and meta-analysis. J Cancer Res Ther 15:1450–1463
Wells GA, Shea B, O’Connell Da, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses: Oxford, 2000
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13
Junfeng Z, Yan S, Bo T, Yingxue H, Dongzhu Z, Yongliang Z, Feng Q, Peiwu Y (2014) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc 28:1779–1787
Ye S-P, Shi J, Liu D-N, Jiang Q-G, Lei X, Qiu H, Li T-Y (2019) Robotic-assisted versus conventional laparoscopic-assisted total gastrectomy with D2 lymphadenectomy for advanced gastric cancer: short-term outcomes at a mono-institution. BMC Surg 19:86
Yang C, Shi Y, Xie S, Chen J, Zhao Y, Qian F, Hao Y, Tang B, Yu P (2020) Short-term outcomes of robotic- versus laparoscopic-assisted Total Gastrectomy for advanced gastric Cancer: a propensity score matching study. BMC Cancer 20:669
Sun L-F, Liu K, Su X-S, Wei X, Chen X-L, Zhang W-H, Chen X-Z, Yang K, Zhou Z-G, Hu J-K (2019) Robot-assisted versus laparoscopic-assisted gastrectomy among gastric cancer patients: a retrospective short-term analysis from a single institution in China. Gastroenterol Res Pract 2019:9059176
Roh CK, Choi S, Seo WJ, Cho M, Choi YY, Son T, Hyung WJ, Kim H-I (2020) Comparison of surgical outcomes between integrated robotic and conventional laparoscopic surgery for distal gastrectomy: a propensity score matching analysis. Sci Rep 10:485
Gao Y, Xi H, Qiao Z, Li J, Zhang K, Xie T, Shen W, Cui J, Wei B, Chen L (2019) Comparison of robotic- and laparoscopic-assisted gastrectomy in advanced gastric cancer: updated short- and long-term results. Surg Endosc 33:528–534
Hyun M-H, Lee C-H, Kwon Y-J, Cho S-I, Jang Y-J, Kim D-H, Kim J-H, Park S-H, Mok Y-J, Park S-S (2013) Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol 20:1258–1265
Kang BH, Xuan Y, Hur H, Ahn CW, Cho YK, Han S-U (2012) Comparison of surgical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: the learning curve of robotic surgery. J Gastric Cancer 12:156–163
Kim M-C, Heo G-U, Jung G-J (2010) Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 24:610–615
Kim KM, An JY, Kim HI, Cheong JH, Hyung WJ, Noh SH (2012) Major early complications following open, laparoscopic and robotic gastrectomy. Br J Surg 99:1681–1687
Kong Y, Cao S, Liu X, Li Z, Wang L, Lu C, Shen S, Zhu H, Zhou Y (2020) Short-term clinical outcomes after laparoscopic and robotic gastrectomy for gastric cancer: a propensity score matching analysis. J Gastrointest Surg 24:531–539
Lee J, Kim Y-M, Woo Y, Obama K, Noh SH, Hyung WJ (2015) Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy. Surg Endosc 29:3251–3260
Liu H-B, Wang W-J, Li H-T, Han X-P, Su L, Wei D-W, Cao T-B, Yu J-P, Jiao Z-Y (2018) Robotic versus conventional laparoscopic gastrectomy for gastric cancer: a retrospective cohort study. Int J Surg 55:15–23
Noshiro H, Ikeda O, Urata M (2014) Robotically-enhanced surgical anatomy enables surgeons to perform distal gastrectomy for gastric cancer using electric cautery devices alone. Surg Endosc 28:1180–1187
Park JY, Ryu KW, Reim D, Eom BW, Yoon HM, Rho JY, Choi IJ, Kim Y-W (2015) Robot-assisted gastrectomy for early gastric cancer: is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy? World J Surg 39:1789–1797
Li Z, Li J, Li B, Bai B, Liu Y, Lian B, Zhao Q (2018) Robotic versus laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis. Cancer Manag Res 10:705–714
Pugliese R, Maggioni D, Sansonna F, Costanzi A, Ferrari GC, Di Lernia S, Magistro C, De Martini P, Pugliese F (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surg Endosc 24:2594–2602
Ryan S, Tameron A, Murphy A, Hussain L, Dunki-Jacobs E, Lee DY (2020) Robotic versus laparoscopic gastrectomy for gastric adenocarcinoma: propensity-matched analysis. Surg Innov 27:26–31
Hikage M, Tokunaga M, Makuuchi R, Irino T, Tanizawa Y, Bando E, Kawamura T, Terashima M (2018) Comparison of surgical outcomes between robotic and laparoscopic distal gastrectomy for cT1 gastric cancer. World J Surg 42:1803–1810
Cianchi F, Indennitate G, Trallori G, Ortolani M, Paoli B, Macrì G, Lami G, Mallardi B, Badii B, Staderini F, Qirici E, Taddei A, Ringressi MN, Messerini L, Novelli L, Bagnoli S, Bonanomi A, Foppa C, Skalamera I, Fiorenza G, Perigli G (2016) Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study. BMC Surg 16:65
Han D-S, Suh Y-S, Ahn HS, Kong S-H, Lee H-J, Kim W-H, Yang H-K (2015) Comparison of surgical outcomes of robot-assisted and laparoscopy-assisted pylorus-preserving gastrectomy for gastric cancer: a propensity score matching analysis. Ann Surg Oncol 22:2323–2328
Suda K, Man-I M, Ishida Y, Kawamura Y, Satoh S, Uyama I (2015) Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc 29:673–685
Huang K-H, Lan Y-T, Fang W-L, Chen J-H, Lo S-S, Li AF-Y, Chiou S-H, Wu C-W, Shyr Y-M (2014) Comparison of the operative outcomes and learning curves between laparoscopic and robotic gastrectomy for gastric cancer. PLoS ONE 9:e111499
Kim H-I, Han S-U, Yang H-K, Kim Y-W, Lee H-J, Ryu KW, Park J-M, An JY, Kim M-C, Park S, Song KY, Oh SJ, Kong S-H, Suh BJ, Yang DH, Ha TK, Kim YN, Hyung WJ (2016) Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg 263:103–109
Lu J, Zheng H-L, Li P, Xie J-W, Wang J-B, Lin J-X, Chen Q-Y, Cao L-L, Lin M, Tu R-H, Huang Z-N, Huang C-M, Zheng C-H (2018) A propensity score-matched comparison of robotic versus laparoscopic gastrectomy for gastric cancer: oncological, cost, and surgical stress analysis. J Gastrointest Surg 22:1152–1162
Pan H-F, Wang G, Liu J, Liu X-X, Zhao K, Tang X-F, Jiang Z-W (2017) Robotic versus laparoscopic gastrectomy for locally advanced gastric cancer. Surg Laparosc Endosc Percutan Tech 27:428–433
Coburn NG (2009) Lymph nodes and gastric cancer. J Surg Oncol 99:199–206
Shen W, Xi H, Wei B, Cui J, Bian S, Zhang K, Wang N, Huang X, Chen L (2016) Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes. Surg Endosc 30:574–580
Yang SY, Roh KH, Kim Y-N, Cho M, Lim SH, Son T, Hyung WJ, Kim H-I (2017) Surgical outcomes after open, laparoscopic, and robotic gastrectomy for gastric cancer. Ann Surg Oncol 24:1770–1777
Lu J, Zheng C-H, Xu B-B, Xie J-W, Wang J-B, Lin J-X, Chen Q-Y, Cao L-L, Lin M, Tu R-H, Huang Z-N, Lin J-L, Zheng H-L, Huang C-M, Li P (2021) Assessment of robotic versus laparoscopic distal gastrectomy for gastric cancer: a randomized controlled trial. Ann Surg 273:858–867
Lee JH, Kang JW, Nam BH, Cho GS, Hyung WJ, Kim MC, Lee HJ, Ryu KW, Ryu SW, Shin DW, Kim CY (2017) Correlation between lymph node count and survival and a reappraisal of lymph node ratio as a predictor of survival in gastric cancer: a multi-institutional cohort study. Eur J Surg Oncol 43:432–439
Kim MS, Kim WJ, Hyung WJ, Kim H-I, Han S-U, Kim Y-W, Ryu KW, Park S (2021) Comprehensive learning curve of robotic surgery: discovery from a multicenter prospective trial of robotic gastrectomy. Ann Surg 273:949–956
Luscieti P, Hubschmid T, Cottier H, Hess MW, Sobin LH (1980) Human lymph node morphology as a function of age and site. J Clin Pathol 33:454–461
Acknowledgements
We thank Peng-bo Yu of Jiangnan University, who majored in translation studies, for revising the language of this article.
Funding
Domestic support from (1) National Natural Science Foundation of China (No. 81772547); (2) the Fundamental Research Funds for the Central Universities (No. 2017SCU04A18); (3) Young Scientific and Academic Leaders Training Program of Sichuan University (No. 0082604151001/035); (4) Foundation of Science & Technology Department of Sichuan Province (No. 2019YFS0256); (5) 1. 3. 5 Projects for Disciplines of Excellence, West China Hospital, Sichuan University (No. ZY2017304).
Author information
Authors and Affiliations
Contributions
Study conception and design: TJ, H-DL, J-KH, and KY; Acquisition of data: TJ, H-DL, J-KH, and KY; Analysis and interpretation of data: TJ, H-DL, J-KH, and KY; Drafting of manuscript: TJ, J-KH, KY, and Z-HC; Critical revision: TJ, J-KH, KY, and Y-XZ; Approval of final manuscript: all authors.
Corresponding author
Ethics declarations
Conflict of interest
There is no conflict of interest.
Ethical approval
All analyses were based on previously published studies; thus, no ethical approval or patient consent was required.
Informed consent
For this type of study, formal consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Jin, T., Liu, HD., Yang, K. et al. Effectiveness and safety of robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a meta-analysis of 12,401 gastric cancer patients. Updates Surg 74, 267–281 (2022). https://doi.org/10.1007/s13304-021-01176-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-021-01176-3